In a patient with mild upper respiratory symptoms and elevated Serum Glutamic-Pyruvic Transaminase (SGPT) and total bilirubin, is repeating labs the best initial approach?

From the Guidelines

Repeating labs is not the best initial approach for a patient with mild upper respiratory symptoms and elevated SGPT (ALT) and total bilirubin. Instead, a more comprehensive evaluation should be undertaken immediately, as suggested by the guidelines on the management of abnormal liver blood tests 1. This should include a complete history focusing on medication use (including over-the-counter drugs, supplements, and herbal remedies), alcohol consumption, recent travel, and risk factors for viral hepatitis. A thorough physical examination should be performed, looking for signs of chronic liver disease. Additional laboratory tests should be ordered concurrently, including a complete liver panel (AST, alkaline phosphatase, GGT, albumin, PT/INR), hepatitis serologies (HAV, HBV, HCV), and tests for other causes of liver injury such as autoimmune markers (ANA, ASMA), iron studies, and ceruloplasmin if appropriate. Abdominal ultrasound should also be considered to evaluate liver architecture and rule out biliary obstruction. This approach is justified because simply repeating labs delays diagnosis and management of potentially serious underlying liver disease, which may be unrelated to the upper respiratory symptoms, as highlighted in the american gastroenterological association medical position statement: evaluation of liver chemistry tests 1. The combination of respiratory symptoms and liver abnormalities could indicate systemic infections like EBV, CMV, or other viral illnesses that require specific management strategies. Given the patient's age and mild symptoms, it is essential to rule out any underlying conditions that may be causing the elevated liver enzymes and bilirubin, as outlined in the guidelines on the management of abnormal liver blood tests 1. By taking a comprehensive approach, the patient's morbidity, mortality, and quality of life can be improved by promptly identifying and managing any underlying liver disease. Key considerations in the evaluation of abnormal liver chemistries include the clinical context of the patient, the presence of symptoms, and the severity of the laboratory abnormalities, as emphasized in the american gastroenterological association medical position statement: evaluation of liver chemistry tests 1. In patients with significant symptoms, evidence of chronic or decompensated liver disease, or severe liver chemistry abnormalities, a complete and expeditious evaluation is essential, as recommended by the guidelines on the management of abnormal liver blood tests 1. Ultimately, the goal is to provide a rational approach for the interpretation and evaluation of abnormal serum liver chemistries, prioritizing the patient's morbidity, mortality, and quality of life.

From the Research

Patient Evaluation

• The patient is a 36-year-old with mild upper respiratory symptoms, total bilirubin of 1.1, and SGPT of 70.
• The elevated SGPT level indicates liver injury, but the cause is unclear 2.
• The patient's symptoms and lab results do not suggest severe liver disease, but further evaluation is needed to determine the cause of the elevated SGPT.

Laboratory Tests

• The SGOT/SGPT ratio can help differentiate between alcoholic liver disease and other causes of liver injury 3.
• However, this patient's symptoms do not suggest alcoholic liver disease.
• Other laboratory tests, such as viral markers and autoimmune hepatitis tests, may be necessary to determine the cause of the elevated SGPT 4, 5.

Management

• Repeating labs may be a reasonable initial approach to determine if the elevated SGPT is a transient or persistent abnormality 2.
• However, if the patient's symptoms worsen or the lab results show significant abnormalities, further evaluation and referral to a specialist may be necessary 6, 4.
• The patient's clinical presentation and lab results should be monitored closely to determine the best course of management.